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Biomedical subjects

C Masquet

Publications and source records attributed to C Masquet.

At least 19 recordsLinked to original sources

[Effects of the parenteral administration of trinitroglycerin on myocardial function, coronary flow and myocardial oxygen consumption in the coronary artery disease patient (author's transl)].

An angiographic study, combined with the determination of coronary flow (thermodilution) and of coronary arteriovenous difference was performed in 10 patients with coronary artery disease under basal conditions and following an infusion of trinitroglycerine. The following changes were noted under the influence of trinitroglycerine: significant fall in left ventricular telediastolic pressure (40%), telediastolic volume (18%), telediastolic strain (53%), mean aortic pressure (11%) and mean systolic strain (21%). Significant increase in ejection fraction (8%), mean shortening (Vcf: 22%) and thickening (Vep: 22%) rates. Significant fall in coronary flow (11%) without any change in coronary arteriovenous difference. Decrease in myocardial oxygen consumption parallel to the reduction in mean systolic strain. These results indicate that the essential mechanism of haemodynamic and metabolic action of trinitroglycerine is located at the level of "load", in particular "preload".

Adult

[Acute tubular necrosis in acute alcoholic hepatitis with cardiac beriberi (author's transl)].

In one case of fulminant hepatic failure by acute alcoholic hepatitis, renal failure seemed to be related to active renal vasoconstriction by systemic endotoxemia due to impaired hepatic clearance of toxins, associated with or complicated by a located intravascular coagulation with acute tubular necrosis. The associated thiamin deficiency may have accentuated this renal vasoconstriction.

Acute Disease

Post-extrasystolic left ventricular peak pressure with and without left ventricular failure.

18 patients without valvular pathology, coronary artery disease, or idiopathic hypertrophic subaortic stenosis were haemodynamically and angiographically investigated in order to analyse the effects of a ventricular extrasystolic beat upon the post-extrasystolic left ventricular peak pressure. In eight normal patients (group I), the post-extrasystolic peak pressure (P.ES.P.P.) was lower than that of the pre-extrasystolic beat; in 10 patients with symptoms of left ventricular failure (group II) the P.ES.P.P. significantly increased. The reasons are: 1) cardiac origin: stroke volume increased more in group II; 2) arterial origin. a) aortic compliance was lower in group II (this is probably related to the older age of patients in group II), and by decrease in end-diastolic aortic pressure was smaller in group II. Part of this arterial effect (2b) may probably be explained from the fact that post-extrasystolic compensatory pauses are equal in both groups, but the decay time of arterial pressure during diastole (assuming an exponential decay) is larger in group II. At the same age and with the identical aortic compliance only the two factors 1 and 2b play a part in the changes in P.ES.P.P.

Adult

[Acute myocarditis simulating myocardial infarct with regressive heart failure].

Two patients were hospitalised with severe heart failure and hypotension thought initially to be due to acute anterior myocardial infarction because of very suggestive electrocardiographic appearances. Heart failure rapidly regressed in both cases. The young age of these two patients, the pyrexia, rapid and total regression of the ECG appearances, the absence of atheromatous lesions at coronary angiography and clinical cure with a follow-up of 10 years in one of the cases, were factors in favour of the diagnosis of acute myocarditis.

Adult

Correlation between angiographic and ECG signs location in unstable angina.

The authors examine if the modifications of the ventricular repolarisation in patients with unstable angina have a value in localizing the site of the coronary stenoses. The relationship between ECG changes and angiographic abnormalities, as yet unrecognized, is studied in 200 patients. The subendocardial signs have little value in predicting the place of the narrowings, they often involve the lateral leads and join with diffused coronary lesions. Subepicardial ECG changes, however, have a good value for prediction: the involvement of inferior leads implies a right coronary stenosis, and that of septal leads a left anterior descending stenosis. The importance of a systematic recording of these ECG changes in unstable angina before performing coronary angiography is discussed. They should be able to specify the ischemic area of the myocardium and then help clinicians to decide when coronarography (and bypass surgery) is indicated.

Angina Pectoris

Relationships between hemodynamic profiles and topography of acute myocardial infarction.

Initial hemodynamics were studied in 101 patients with acute myocardial infarction complicated by shock or left heart failure. 59 had anterior myocardial infarction (AMI); 42 had inferior myocardial infarction (IMI). Data were processed by univariate analysis and correspondence analysis. AMIs and IMIs were significantly different on conduction disturbances, heart rate, left ventricular filling pressure, mean pulmonary artery pressure and right ventricular function indices. Both patients and parameters were projected on the most meaningful factorial plane generated by correspondence analysis. This two-dimensional graphical representation showed that all the information was roughly distributed along the 2 orthogonal axes defining this plane. Survivors and nonsurvivors were fairly well separated along the first factorial axis (prognostic axis) which was highly correlated with both outcome and left ventricular function parameters. AMIs and IMIs were grossly separated along the second factorial axis (topographical axis) which was rather well correlated with location and right ventricular function parameters. These studies suggest that AMI and IMI hemodynamic profiles are modulated by the presence or absence of right ventricular dysfunction. Moreover right ventricular dysfunction may be held responsible of some lack of information about left ventricular function status.

Acute Disease

Evaluation of the elasticity and characteristic impedance of the ascending aorta in man.

In 30 patients, simultaneous measurements of ascending aortic pressure and diameter were performed, allowing one to evaluate: (1) the influence of age, the aortic diastolic pressure, and the radius on the aortic elasticity; (2) the correlations between characteristics impedance of the aorta (Zo), systemic arterial resistance, age and diastolic aortic pressure; and (3) the importance of Zo when comparing two indices of left ventricle performance; one during isovolumic phase ([dP/dt]/Pt)max and the other during the outflow phase (maximum acceleration of aortic blood flow).

Adult

[Hemodynamic and coronary effects of atrial stimulation in normal subject and patients with coronary disease: correlation with coronary arteriography].

Thirty-two patients (group I: 7 normal subjects; group II: 25 coronary subjects) underwent coronary arteriography, and measurements were made both in normal rhythm and under atrial stimulation of the pulmonary capillary pressure and the pressure in the femoral artery, of cardiac output, of coronary sinus flow (by continuous thermodilution), of the coronary arterio-venous oxygen difference, of oxygen consumption, and in 28 of the patients of the coefficient of extraction of K lactates. During stimulation, the only differences to appear between the subjects of group I and group II were an increase in capillary pressure (p less than 0.01) and a decrease in the coefficient of extraction of lactates (p less than 0.001) in the coronary patients. Similar differences were found between coronary patients with a stenosis greater than 70% in the anterior descending or circumflex artery (group IIa) and those without it (group 11b), and between the patients with pain during atrial stimulation (n = 9) and those without it. There was a good correlation between a double score (IVA + circumflex artery, Rowe's method) and the coefficient of extraction of lactates during atrial stimulation (n = 28, p less than 0.01).

Adult

[A simplified arteriographic analysis of systolic pressure and of the pressure-time index].

Systolic stress has been measured in 20 ms periods during ventricular ejection by monoplanar angiographic method, both under basal conditions and after infusion of trinitro-glycerine (TNG) in 8 coronary patients. None of them showed significant segmental contraction abnormality. No correlation was found between the corresponding values of mean systolic stress sigma and mean systolic pressure P, either under basal conditions (r=0.48) or after reduction of the load (r=0.24). On the other hand, values of sigma correlated closely with the corresponding values of the stress sigmas at the end of the isovolumic contraction phase, both under basal conditions (r=0.95) and after TNG (r=0.98. A similar correlation was found between the corresponding values of the peak of systolic stress and of sigmas both under basal conditions (r=0.94) and after TNG (r=0.96). Determination of sigmas is technically simple, and only requires the calculation of ventricular end-diastolic volume, together with measurement of end-diastolic thickness and aortic diastolic pressure. This simplified angiographic method is useful to express the determinants of myocardial energy using parietal stress values instead of intracavitary pressure values.

Angiography

[Myxoma of the left atrium diagnosed by pathological examination of an embolism of the aortic bifurcation (author's transl)].

The case reported was a 69-year-old patient with a myxoma of the left atrium presenting as multiple emboli: acute ischaemia of the lower limbs preceded, three months before, by a spontaneously regressive right hemiplegia which, in view of the patient's age, was considered to be a simple manifestation of atherosclerosis. The diagnostic value of the echocardiogram in cases of systemic emboli of undetermined origin is stressed.

Aged

Clinical and hemodynamic results of intraortic balloon counterpulsation and surgery for cardiogenic shock.

Forty-two patients with cardiogenic shock (CS) secondary to myocardial infarction were treated with intra-aortic balloon pumping (I.A.B.P.). In 14 patients C.S. was associated with ventricular septal defect (V.S.D.) and in four with mitral regurgitation (M.R.) secondary to rupture of the posterior papillary muscle. All patients were resistant to conventional medical therapy. Shock was reversed in 20 of the 24 patients in C.S. without mechanical complications. After 24 to 48 hours of I.A.B.P., cardiax index (C.I.) increased from 1.38 to 2.00 L./min./M2, systolic arterial pressure (S.A.P.) from 83 to 96 mm. Hg, urinary output (U.O.) from 10 to 56 ml. per hour, and pulmonary wedge pressure (P.W.P.) decreased from 22 to 16 mm. Hg. Three patients treated with I.A.B.P. alone survived more than 1 year; of the 13 patients who were balloon dependent, four have undergone emergency surgical procedures and two were long-term survivors. In all patients with mechanical complications, I.A.B.P. resulted in significant clinical and hemodynamic improvement. P.W.P. decreased from 19 to 15 mm. Hg, and U.O. increased from 13 to 38 ml. per hour while S.A.P. remained unchanged. In patients with V.S.D. the pulmonary/systemic flow ratio (P/S) declined from 3.5 to 2.8; in patients with M.R., "V" wave amplitude decreased by 8 mm. Hg. Emergency surgery was performed in 10 patients with V.S.D. and in three patients with M.R. and there were eight long-term survivors (13 to 27 months). It is concluded that I.A.B.P. is an effective means of supporting the circulation in C.S. Of the 42 patients with C.S. treated by combining I.A.B.P. and emergency surgery, 13(31%) were long-term survivors (20 +/- 6 months).

Adult

[Emergency treatment of mechanical complications of acute myocardial infarction. Septum perforations and mitral insufficiency].

Over the last three years, thanks on the one hand to improvements in surgical techniques and ressuscitation, and on the other to assisted circulation using the intra-aortic balloon, which allows improved preoperative preparation of the patients, urgent medicosurgical treatment of the mechanical complications of infarction has improved the prognosis by comparison with the recent past. During the above period, our figures for operative intervention during the first two weeks after an acute infarction have been as follows: 1. Twenty nine cases of septal perforation (17 of which had previously had assisted circulation by balloon): there were 8 immediate deaths and 8 successful cases (no secondary deaths over a follow-up period of from 2 to 41 months). In all these cases, the surgeon approached the perforation by way of the left ventricle. No patient required an additional bypass procedure. Where indicated, assisted circulation by means of a balloon should not be continued for more than a few days. If there is no improvement with its use, it seems unreasonable to proceed to surgery regardless. 2. Ten cases of acute mitral incompetence; 8 were due to ruptured papillary muscle and two to mal function. 5 patients out of the 10 had required circulatory assistance by balloon preoperatively. There were 2 immediate deaths and 8 successful cases, with one secondary death (follow-up period of between 2 and 37 months).

Acute Disease

[Role of the characteristic impedance of the ascending aorta in the evolution of indices of left ventricular performance during the ejection stage].

In this study of 61 patients (group I: 37 patients with no signs of cardiac failure, group II: 24 patients with signs of cardiac failure), a comparison is made between the indices of left ventricular performance obtained during the isovolumic phase dp/dt/Pt max of the left ventricle (5F Millar micromanometer) and in the ejection phase (ejection fraction, mean speed of fibre contraction, corrected mean systolic ejection speed (left ventricular cineanigiography) and maximal acceleration of the aortic blood flow (electromagnetic velocimeter). Calculations were also made of the modulus of elasticity (Ep) and the characteristic impedance of the ascending aorta (Zo) in every patient. The results show that, for group I patients the correlation between the indices in the isovolumic and ejection phases is improved by taking Zo into account. This result is not true for group II cases except with respect to the acceleration of aortic blood flow. An analysis has been made of the hypotheses and the discrepancies.

Adult

[The relationship between left ventricular end-systolic pressure and volume. Comparative study of changes in load and inotropism].

This work consists of a comparison of the indices of left ventricular performance measured during the isovolumic nad/or ejection period under changes in load and inotropism, and of the findings on measuring the pressure/volume ratio of the left ventricle. The indices of performance of the left ventricle. The indices of performance of the left ventricle during the ejection phase (ejection fraction, mean speed of fibre shortening, mean standardised speed of systolic ejection) and the ratio pressure/volume were listed for 36 patients, 21 of them before and after perfusion with nitroprussiate, in 6 before and after perfusion of angiotensine, and in 9 from the group before and after post-extra-systolic potentialisation. The indices of left ventricular performance during the isovolumic (formula see text) were measured in 24 of these patients, 15 of them before and after nitroprussiate, and 9 before and after post-extra-systolic potentialisation. These results show that the level of the pressure/volume ratio at the moment of end-systole is independent of the conditions of load--to a greater extent than any other index measured during the isovolumic period or ejectional period--and appears to be thoroughly related to the changes of inotropism.

Adult